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<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
<link rel="stylesheet" type="text/css" href="css/mainpage.css" />
<link href="css/bootstrap.min.css" rel="stylesheet" media="screen">
</head>

<body>
<?php

$host="localhost"; 
$username="root"; 
$password=""; 
mysql_connect("$host", "$username", "$password")or die("cannot connect server "); 
mysql_select_db('Incofarming_db')or die("cannot select DB");

$prov_query = "SELECT * FROM provinsi";
$prov_result = mysql_query($prov_query);

?>
<div id="container">
	<div id="header">
		<div id="logo">
<img src="img/LOGO.JPG"/>
		</div>
       	<div align="right">
            	<a href="...">logout</a>
       	</div>
	</div>
    <div class="container-fluid">
      <div class="row-fluid">
        <div class="span3">
          <div class="well sidebar-nav">
            <ul class="nav nav-list">
              <li class="nav-header"></li>
              <li><a href="dashkop_view.php">Dashboard</a></li>
              <li class="active"><a href="#">Manajemen Profil</a></li>
              <li><a href="manajemenproduk_view.php">Manajemen Produk</a></li>
              
            </ul>
          </div><!--/.well -->
        </div><!--/span-->
      <div class="span9">
      <h2 align="center"> EDIT USER </h2>

<form class="form-horizontal">  
        <fieldset>  
          <div class="control-group">  
            <label class="control-label" for="input01">User Name</label>  
            <div class="controls">  
              <input type="text" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  <div class="control-group">  
		  
		  <fieldset>  
          <div class="control-group">  
            <label class="control-label" for="input01">Password</label>  
            <div class="controls">  
              <input type="text" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  <div class="control-group"> 
		  
            <label class="control-label" for="input01">Nama Koperasi</label>  
            <div class="controls">  
              <input type="text" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  
		  <div class="control-group">  
            <label class="control-label" for="input01">Alamat Koperasi</label>  
            <div class="controls">  
              <input type="text" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  <div class="control-group">  
            <label class="control-label" for="select01">Provinsi</label>  
            <div class="controls">  
               <select onChange id="select01" name="provinsi">  
                <?php
				while($row = mysql_fetch_array($prov_result)){
			?>
            	<option value="<?php echo $row['IDPROPINSI']; ?>"><?php echo $row['NAMAPROPINSI']; ?> </option>
            <?php } ?>  
              </select>  
            </div>  
          </div>
		  <div class="control-group">  
            <label class="control-label" for="select01">Kota</label>  
            <div class="controls">  
              <select id="select01">  
                <option>Aceh</option>  
                <option>2</option>  
                <option>3</option>  
                <option>4</option>  
                <option>5</option>  
              </select>  
            </div>  
          </div>
          <div class="control-group">  
            <label class="control-label" for="input01">No Kantor</label>  
            <div class="controls">  
              <input type="text" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  <div class="control-group">  
            <label class="control-label" for="input01">No Fax</label>  
            <div class="controls">  
              <input type="text" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  <div class="control-group">  
            <label class="control-label" for="input01">Tanggal Pendirian</label>  
            <div class="controls">  
              <input type="date" class="input-xlarge" id="input01">   
            </div>  
          </div>
		  <div class="control-group">  
            <label class="control-label" for="fileInput">Foto Lokasi</label>  
            <div class="controls">  
              <input class="input-file" id="fileInput" type="file">  
            </div>  
          </div>  
          <div class="control-group">  
            <label class="control-label" for="textarea">Informasi Koperasi</label>  
            <div class="controls">  
              <textarea class="input-xlarge" id="textarea" rows="3"></textarea>  
            </div>  
          </div>  
          <div class="form-actions">  
            <button type="submit" class="btn btn-primary">Save changes</button>  
            <button class="btn">Cancel</button>  
          </div>  
        </fieldset>  
</form> 
      </div>
      </div> 
</div>
<script src="js/jquery-latest.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/jquery.js"></script>
</body>
</html>